Case report: salvage fractionated high dose rate after-loading brachytherapy in the treatment of a recurrent tumour in the middle ear

Re-irradiation of previously irradiated head and neck sites is associated with a high complication rate. In an attempt to reduce this complication risk, multiple fractions of high dose rate (HDR) intracavitary irradiation were used in a young patient who had developed recurrent transitional cell carcinoma in the tympanic cavity one year after radical radiotherapy. After gross surgical removal of the tumour, an afterloading probe was placed into the middle ear by a surgical approach. In 11 treatments of 3 Gy each over 4 days, a total dose of 33 Gy was delivered to a spherical volume, 1.7 cm in diameter. The patient was 24 months free of disease at the start of 1993. Audiometry shows no severe deterioration of hearing. We concluded that fractionated HDR brachytherapy can be used to achieve local control in small volume recurrences at previously irradiated sites, without the inevitability of complications.

Psychological moderator variables and metabolic control in recent onset type 1 diabetic patients--a two year longitudinal study

The relationships between psychosocial adjustment and subsequent glycaemic control were prospectively examined in forty-three adult patients during the first 2 yr after onset of type 1 diabetes mellitus. Decreasing depression was the single psychosocial parameter that changed over time. No correlations were found between the decrease in HbA1c levels and psychological variables at 8- and 16-month follow-ups. Global and specific coping features such as high control attitude, low coping anxiety and low emotional attribution correlated significantly with the decrease in HbA1c levels at the 2-yr follow-up, whereas stressful life events, depression, state-trait anxiety did not correlate. In a regression analysis coping explained 22% variance of the 2 yr decrease in HbA1c levels. We conclude that coping is a better predictor for metabolic control than emotional adaptation and life events. Metabolic control might deteriorate with prolonged stage of the disease being a first sign for psychophysiological coping exhaustion.

Immunoperoxidase test for rabies: utility as a diagnostic test

Although a fast and reliable fluorescent antibody (FA) test for rabies diagnosis is available, ideally the diagnostic procedure requires fresh or frozen brain tissues. In some instances (and particularly for retrospective studies), fresh or frozen tissues may not be available. In such cases, immunohistochemical tests may be utilized. Because such tests have been used only in a limited number of cases, their diagnostic reliability has not been thoroughly evaluated. This study documents the results of a streptavidin-biotin complex (ABC) immunoperoxidase test on formalin-fixed, paraffin-embedded brain tissues of domestic and wild animals that were positive on FA test for rabies prior to fixation. Thirty-nine of 40 rabies cases were positive with the ABC technique. Based on these preliminary results, the ABC technique appears reliable. However, more corroborative test results are needed before the ABC method can be used as a routine diagnostic procedure, especially with field samples and negative controls.

[Neurologic complications of osteoporotic spinal collapses. Apropos of 8 cases]

The prevalence of neurological complications in patients with osteoporotic vertebral collapse and the risk factors for neurological compromise were studied retrospectively in 138 inpatients. Six per cent of patients had objective neurological loss. Patients with neurological loss were more likely to have changes suggestive of malignant disease on roentgenograms, computed tomography, and magnetic resonance imaging. Diagnosis was based on magnetic resonance imaging and examination of vertebral biopsy specimens. Comparison of patients with and without neurological loss suggested that an intravertebral vacuum phenomenon and/or a cortical osteoporosis may cause fracture of the posterior wall and therefore compression of neurological structures.

Hormonal and blood glucose responsiveness as an indicator of specific emotional arousal in type 1 diabetics

The aim of the present study was to examine, whether individual emotional arousal induced by a specific stress interview may effect growth hormone (GH), cortisol, catecholamine and blood glucose levels in diabetes patients. To test the validity of this hypothesis we subjected 18 Type 1 diabetics and 18 healthy controls to a life event interview which produces individual arousal. During this stress interview catecholamines and plasma cortisol levels showed no significant increase, whereas there was a significant increase of GH over time in both group (p < 0.04), with a trend in diabetics to have a more marked GH response than controls (p < 0.10). Blood glucose levels remained unaffected by the interview. Depressed diabetics showed significantly higher cortisol increases (p < 0.004) than non-depressed diabetics, whereas there was no difference among depressed and non-depressed controls. Depression was not associated with an increase of other hormones or blood glucose levels in both groups. The results of our study confirm specific pathways in which individual emotional arousal and depression may lead to chronic metabolic disturbances as a result of GH and cortisol hypersecretion.

Immunohistochemical study to demonstrate Sarcocystis neurona in equine protozoal myeloencephalitis

A 5-year (1985-1989) retrospective immunohistochemical study was conducted using an avidin-biotin complex (ABC) immunoperoxidase method to demonstrate Sarcocystis neurona in histologically suspect cases of equine protozoal myeloencephalitis (EPM). Primary antibodies against S. neurona and S. cruzi were utilized for the ABC technique. The findings were compared with those from cases in which the organisms were detected by examination of hematoxylin and eosin (HE)-stained neuronal sections. HE-stained sections detected the presence of the organisms in 20% of the suspect cases; whereas the ABC technique confirmed the presence of S. neurona in 51% and 67% of the cases by S. neurona and S. cruzi antibodies, respectively. A review of clinical case histories showed that 21/47 (45%) of the EPM horses with parasites in the tissue sections had prior treatment with antiprotozoal drugs and/or steroids. Using the test results of S. neurona and S. cruzi as a standard reference, HE test sensitivity based on examination of up to 30 neuronal sections per case was only 25%, and test specificity was 91%.

Esophageal motor disorders: videofluoroscopic and manometric evaluation--prospective study in 88 symptomatic patients

Esophageal motor disorders are best evaluated with manometry, which, however, is time-consuming and not generally available. The authors prospectively investigated the yield of videofluoroscopy in detection of esophageal motor disorders in comparison with that of manometry. Eighty-eight patients with dysphagia, globus sensation, noncardiac chest pain, or progressive systemic sclerosis underwent both manometry and videofluoroscopy at 0-32-day intervals. Videofluoroscopy was performed with one swallowing study in the upright position and up to three swallowing studies in the prone oblique position. Manometric diagnoses of achalasia (n = 15), diffuse esophageal spasm (n = 1), nonspecific esophageal motor disorders (n = 44), and adynamic esophagus (n = 9) were made. Videofluoroscopically, 87% of the patients with achalasia, the one patient with diffuse spasms, 73% of the patients with nonspecific esophageal motor disorders, and all of the patients with adynamic esophagus received a correct diagnosis, for an overall sensitivity of 80%. The radiographic specificity was 79%. The authors conclude that videofluoroscopy is a valuable and reasonably sensitive technique for screening for esophageal motor disorders.

Morphologic and immunoperoxidase study of neurologic lesions in naturally acquired rabies of raccoons

Histopathologic (hematoxylin and eosin [HE]) and immunoperoxidase (streptavidin-biotin complex) methods were used for examination of formalin-fixed tissues of rabid raccoons from an enzootic area of Pennsylvania. Extensive morphologic lesions of rabies encephalitis were present in the cerebrum and the brain stem regions. Negri bodies were detected by both methods and were present in the brain (cerebral cortex, hippocampus, brain stem, cerebellum, and cervical spinal cord) and in the ganglia of the trigeminal nerves. The viral inclusions were also seen in ganglion cells in the tongue, parotid salivary glands, pancreas, intestines, and adrenal glands. These sites were not associated with any inflammatory cellular infiltrate. The immunoperoxidase method was superior to HE for the detection of Negri bodies. Because lesions of rabies encephalitis were consistently observed in the cerebrum, brain stem, and cervical spinal cord regions, these areas of the brain should be included when raccoons are examined by the fluorescent antibody test for rabies.

A five year (1985-1989) retrospective study of equine neurological diseases with special reference to rabies

A retrospective study of horses necropsied between 1985 and 1989 at a diagnostic laboratory of a veterinary school in North America is documented. In this investigation over 20 per cent of the horses had clinical neurological signs. Equine protozoal myeloencephalitis (caused by Sarcocystis neurona) and cervical stenotic myelopathy (wobbler syndrome) were the most common of these disorders. The veterinary school is located in the midst of a raccoon rabies enzootic area. However, only four cases of equine rabies were diagnosed during the 5-year study. The gross microscopical and immunohistochemical findings from these rabies-positive horses are documented. Immunoperoxidase tests for detection of rabies antigen in another 35 horses with non-specific encephalitis/encephalopathy did not reveal any positive cases. Based on this investigation, it appears that immunoperoxidase is a valid method for diagnosis of rabies when fresh tissues are not available for the fluorescent antibody test. It is also concluded that no cases of equine rabies were overlooked by the diagnostic laboratory during the period under investigation.

High incidence of esophageal motor disorders in consecutive patients with globus sensation

Thirty consecutive patients with globus sensation who were referred to a psychosomatic clinic prospectively underwent otolaryngological, videokinematographic, and manometric examinations of pharynx and esophagus to evaluate whether morphological abnormalities or motility disorders underlay their symptom. When indicated by findings, 24-hour pH-metry, scintigraphy of bolus transport, and esophagogastroscopy were performed. Seven patients were shown to have achalasia, 10 had "hypochalasia" (lower esophageal sphincter relaxation less than 75% with esophageal contraction abnormalities but no complete distal aperistalsis), and 1 had diffuse esophageal spasms; 2 patients had also hyperplastic lingual tonsils, 1 had tonsillitis, and 1 had a cervical spondylophyte. Nutcracker esophagus and nonspecific contraction abnormalities were found in 7 patients, and gastroesophageal reflux with esophagitis and a low lower esophageal sphincter resting pressure was found in 1; only 3 patients had normal esophageal motility. None had volunteered dysphagic symptoms at primary evaluation. Psychometric investigations in consenting patients showed no higher mean scores for state and trait anxiety, depression, hysteria, and hypochondriasis than in general medical outpatients. Esophageal motor disorders may, before giving rise to dysphagia, be sensed more vaguely and induce the globus sensation. However, only disappearance of the sensation after treatment allows inferring an etiological significance of such a disorder.

[Glycosylated hemoglobin and diabetes--self monitoring (compliance) in depressed and non-depressed type I diabetic patients]

128 type I diabetics were examined in view of connections between psychosocial factors and metabolic control. Indications of a direct interaction between depressivity, incidence of complaints and the level of hyperglycemia were found. The prevalence of manifest depression ranges at a total of 25 percent. The results further show connections between coping with the disease and behavior. High recording frequency, frequent measurements and medical consultations are found in active coping. Changes in relations to close persons and frequent change of job are psychosocial effects of the disease manifesting themselves in poorer metabolic control. In conclusion, high-risk groups of depressive diabetes patients and those under particular stress are defined.

Pharmacokinetics of alprazolam in geriatric patients with neurotic depression

The pharmacokinetics of alprazolam was studied in 10 geriatric patients (5 males, 5 females) with neurotic depression during a 6-week period. After 0.5 mg of alprazolam on Day 1 the mean elimination half-life was 11.1 hr and Cmax 12.3 ng/ml. The pharmacokinetic evaluation on Day 1 (t 1/2, tmax) did not differ significantly from the evaluation on Day 42. The mean daily dosage on Day 42 was 1.6 mg alprazolam. The concentrations of the metabolites alpha-OH alprazolam and 4-OH alprazolam were less than 10% of that of alprazolam. All the patients improved clinically. The most common side effect was drowsiness, more often during the first week than the last week.

[Acute tonsillitis: clinical symptoms; bacteriologic culture and rapid test as deciding criteria for the use of antibiotics]

In order to prevent late sequelae from an untreated streptococcal pharyngitis all patients with streptococcal tonsillitis/pharyngitis have to be treated with antibiotics, preferably penicillin. A correct diagnosis by clinical criteria is only achievable in 72% of patients with streptococcal pharyngitis. Additional criteria such as diagnosis by culture are, therefore, mandatory. Time is a major disadvantage of traditional culture methods. Slide agglutination tests show an acceptable sensitivity of 92% and a specificity of 93%. Due to the possibility of false negative test results, with consequent withholding of adequate antimicrobial chemotherapy, these test results should be used only as a valuable guide. Decision to administer an antibiotic should still be based on clinical criteria.

Successful treatment of hemodialysis-related porphyria cutanea tarda with deferoxamine

End-stage renal failure and long-term hemodialysis treatment promote the development of genetically conditioned porphyria cutanea tarda (PCT). The clinical manifestation is triggered off by unknown factors coexisting with renal insufficiency and hemodialysis. Iron overload is often associated with the disease and is thought to play a key role in its pathogenesis. Iron removal by deferoxamine infusions is regarded as the treatment of choice for patients who cannot undergo repeated phlebotomy procedures and has been successfully used in patients with normal renal function. We report a case of hemodialysis-related PCT and iron overload in whom repeated venesections were contraindicated on account of severe anemia and treatment with deferoxamine led to a striking improvement of symptoms.

[The significance of psychosocial complaints in the initial interview--a study of unselected patients of an internal medicine/polyclinic university ambulatory service]

In clinical practice one is repeatedly confronted with patients, who report psycho-social problems during the first interview. In this study 128 patients have been examined in the outpatient clinic at the Department of Medicine 1 of the University Hospital in Vienna. The most important issue investigated was to clarify whether or not the psycho-social complaints expressed at the initial interview could be correlated with either functional disorders or somatic disease. Further we tried to determine whether or not the complaints influenced the course of the disease and gave any indication for the presence of a depressive disorder or complicated a somatic disorder by additional psychosomatic complaints. Our results indicate that the expression of psycho-social problems indeed correlates with stronger psychosomatically conditioned body dysfunctions, but do not sufficiently explain whether or not functional disease can be expected. However, the reported psycho-social problems result in a stronger inclination towards depressive mood and lead the patient to his/her own explanation how the illness has developed. Both facts are of importance for the patient-physician relationship and constitute an integral part of the (non-)compliance.

Lack of association between HLA antigens and anorexia nervosa

Studies of the human leukocyte antigen (HLA) system were performed in 37 patients with anorexia nervosa to confirm an alleged association with HLA-B16 and haplotype HLA-A26,B38. No correlation between anorexia nervosa and HLA, including HLA-DR, could be found.

Distinction between the G0 and the late G1 phase of rat cells in vivo and in vitro with the nuclear QDH-fluorescence pattern

The quinacrine dihydrochloride (QDH) staining and the [3H]thymidine incorporation patterns were simultaneously analyzed in nuclei of rat cells from a proliferating (granulation tissue) and a nonproliferating tissue (liver). Nuclei from freshly isolated and cultured cells of the rapidly proliferating subcutaneous granulation tissue showed a cell cycle-related pattern similar to that previously described with growing fibroblast-like cells in vitro. Nuclei of liver cells in smears from biopsies and in histological sections showed a fluorescence pattern similar to that of serum-deprived arrested G0 cells from established cell lines. Treatment of primary cultured rat hepatocytes with phenobarbital altered their degree of chromatin condensation similar to that seen after treatment of rats in vivo. The data indicate that the QDH staining pattern is an early marker, suitable for detecting the cell cycle-promoting activity of chemicals (e.g., of tumor promoters) in nonproliferating cells from various tissues in vivo and in vitro.

Accessory cells in immune suppression. III. Evidence for two distinct accessory cell-dependent mechanisms of T lymphocyte-mediated suppression

Suppression of antibody secretion by the 2,4,6-trinitrophenol (TNP)-binding BALB/c myeloma, MOPC 315, by idiotype- and hapten-reactive suppressor T cells is mediated by secreted factors (TsF) and requires the presence of accessory cells (AC). Idiotype-specific TsF functions only in the presence of Ia+ AC and is completely idiotype specific. Moreover, no suppression is observed when myeloma targets and AC are separated by cell-impermeable membranes, indicating that the role of AC may be to bind, focus, and/or present TsF to the myeloma cells. In contrast, TNP-specific TsF inhibits myeloma function in the presence of TNP-protein and activated macrophages that are not Ia+. This form of suppression is nonspecific at the effector stage; i.e., anti-TNP TsF inhibits a non-TNP binding cell line, TEPC 15, as long as TNP-protein and activated macrophages are present. Moreover, suppression occurs even when myeloma targets and AC are separated by cell-impermeable membranes. These results are consistent with the view that hapten-reactive TsF binds to antigen on the surface of macrophages and induces these cells to secrete nonspecific immunosuppressive molecules. Thus, different types of AC may play fundamentally different roles in TsF-mediated suppression; they may either bind and present TsF to targets (as in the case of idiotype-specific TsF) or secrete nonspecific immunosuppressants as a consequence of a TsF-antigen interaction (hapten-specific TsF). Autonomous, suppressible targets provide valuable experimental systems for analyzing the cellular interactions in T cell-mediated suppression.

Accessory cells in immune suppression. III. Evidence for two distinct accessory cell-dependent mechanisms of T lymphocyte-mediated suppression

Suppression of antibody secretion by the 2,4,6-trinitrophenol (TNP)-binding BALB/c myeloma, MOPC 315, by idiotype- and hapten-reactive suppressor T cells is mediated by secreted factors (TsF) and requires the presence of accessory cells (AC). Idiotype-specific TsF functions only in the presence of Ia+ AC and is completely idiotype specific. Moreover, no suppression is observed when myeloma targets and AC are separated by cell-impermeable membranes, indicating that the role of AC may be to bind, focus, and/or present TsF to the myeloma cells. In contrast, TNP-specific TsF inhibits myeloma function in the presence of TNP-protein and activated macrophages that are not Ia+. This form of suppression is nonspecific at the effector stage; i.e., anti-TNP TsF inhibits a non-TNP binding cell line, TEPC 15, as long as TNP-protein and activated macrophages are present. Moreover, suppression occurs even when myeloma targets and AC are separated by cell-impermeable membranes. These results are consistent with the view that hapten-reactive TsF binds to antigen on the surface of macrophages and induces these cells to secrete nonspecific immunosuppressive molecules. Thus, different types of AC may play fundamentally different roles in TsF-mediated suppression; they may either bind and present TsF to targets (as in the case of idiotype-specific TsF) or secrete nonspecific immunosuppressants as a consequence of a TsF-antigen interaction (hapten-specific TsF). Autonomous, suppressible targets provide valuable experimental systems for analyzing the cellular interactions in T cell-mediated suppression.

Accessory cells in immune suppression. II. Evidence for presentation of idiotype-specific suppressor factors to B cell targets by I-A+ accessory cells

The functional suppression of two BALB/c myelomas, MOPC315 and MOPC460, by idiotype-specific suppressor T cells is mediated by secreted factors (TsF). Idiotype-specific TsF only functions in the presence of accessory cells (AC) that can be low density splenocytes or cells of BALB/c B lymphoma A20-2J. Such AC are I-A+ but do not have to be histocompatible with the myeloma targets or the source of TsF. A20-2J cells incubated with soluble idiotype and TsF also are capable of suppressing the relevant myeloma target. The effect of TsF-pulsed A20-2J cells is idiotype specific, and these cells do not secrete immunosuppressive mediators. Finally, TsF-pulsed A20-2J cells suppress myeloma targets when the two are cultured on the same side of a cell-impermeable membrane but not when they are separated by the membrane. These results indicate that I-A+ cells are capable of concentrating and/or presenting TsF to suppressible targets, and they demonstrate a novel role for Ia-bearing cells in immune regulation.

Accessory cells in immune suppression. II. Evidence for presentation of idiotype-specific suppressor factors to B cell targets by I-A+ accessory cells

The functional suppression of two BALB/c myelomas, MOPC315 and MOPC460, by idiotype-specific suppressor T cells is mediated by secreted factors (TsF). Idiotype-specific TsF only functions in the presence of accessory cells (AC) that can be low density splenocytes or cells of BALB/c B lymphoma A20-2J. Such AC are I-A+ but do not have to be histocompatible with the myeloma targets or the source of TsF. A20-2J cells incubated with soluble idiotype and TsF also are capable of suppressing the relevant myeloma target. The effect of TsF-pulsed A20-2J cells is idiotype specific, and these cells do not secrete immunosuppressive mediators. Finally, TsF-pulsed A20-2J cells suppress myeloma targets when the two are cultured on the same side of a cell-impermeable membrane but not when they are separated by the membrane. These results indicate that I-A+ cells are capable of concentrating and/or presenting TsF to suppressible targets, and they demonstrate a novel role for Ia-bearing cells in immune regulation.

Blood and urinary magnesium, zinc, calcium, free fatty acids, and catecholamines in type A and type B subjects

Twenty type A male students were compared to nineteen type B male students (all in apparently good health), before and after exposure to combined stress (noise and task). Before stress, red blood cell (RBC) Zn concentration is higher (P less than .05) and Zn excretion lower (P less than .05) in type A than in type B people. After stress, type A subjects exhibit changes that are larger and more significant than those of type B individuals. After stress, the type A group shows an important increase of urinary catecholamines (P = 2.10(-5), serum free fatty acids, and urinary Zn (P = .001); a slight increase in plasma magnesium (P less than .05); and a small but significant decrease in RBC Mg (P less than .02). These results suggest that type A subjects are more sensitive to stress than are type B people and more readily lose their intracellular Mg, the rise in plasma Mg being a transient one, probably consecutive to the cellular loss. The present observations are in good agreement with published data: ie, the psychological characteristics of type A personalities; their greater susceptibility to ischemic heart disease, which has been associated with Mg deficiency; the possible role of hypomagnesemia in the pathogenesis of hypertension and coronary vasospasm; and the high RBC Zn levels found in hypertensive patients.

[25 cases of gastric smooth muscle tumors and review of the literature]

25 gastric smooth muscle tumors (12 symptomatic leiomyomas, 9 fortuitously discovered leiomyomas and 4 leiomyosarcomas) are presented. Follow-up has lasted from 9 months to 9 years. We have correlated the epidemiology, symptoms and anatomopathology with the evolution of these cases, in an attempt to single out specific features of benign and malignant forms. The most relevant macroscopic criteria of malignity are: a tumor measuring over 5 cm in diameter, widespread intratumoral necrosis. The histologic degree of malignity depends on several criteria, of which the most important are: the number of mitoses per high power microscopic field, cellular pleomorphism. Barium meal detects all symptomatic gastric smooth muscle tumors, and echography has the advantage of objectivizing intratumoral necrosis. For benign as well as malignant tumors the excision should be minimal, leaving a 2 cm safety margin. Simple enucleation is ruled out. If possible, metastases should be removed with the same safety margin. There is a good correlation between histologic type and prognosis. One case in 4 is associated with another malignancy.

Accessory cells in immune suppression. I. Role of I-A+ accessory cells in effector phase idiotype-specific suppression of myeloma function

The suppression of MOPC 315 myeloma cells by idiotype-specific effector Ts requires the presence of non-immune AC. This requirement was demonstrated in cultures where myeloma targets and Ts were separated by cell-impermeable membranes or were in direct contact. The AC were adherent, radioresistant, and present in peritoneal exudates and in FcR+ as well as FcR- fractions of low density splenocytes; they bore cell surface I-A determinants and did not have to be H-2 compatible with myeloma cells and Ts. These studies demonstrate a novel role for Ia+ AC in immune regulation, and suggest that their accessory function may involve processing of T lymphocyte-derived suppressor factors or presentation of such factors to target cells.

Accessory cells in immune suppression. I. Role of I-A+ accessory cells in effector phase idiotype-specific suppression of myeloma function

The suppression of MOPC 315 myeloma cells by idiotype-specific effector Ts requires the presence of non-immune AC. This requirement was demonstrated in cultures where myeloma targets and Ts were separated by cell-impermeable membranes or were in direct contact. The AC were adherent, radioresistant, and present in peritoneal exudates and in FcR+ as well as FcR- fractions of low density splenocytes; they bore cell surface I-A determinants and did not have to be H-2 compatible with myeloma cells and Ts. These studies demonstrate a novel role for Ia+ AC in immune regulation, and suggest that their accessory function may involve processing of T lymphocyte-derived suppressor factors or presentation of such factors to target cells.

G0-G1 transition of rat hepatocytes detected by changes in nuclear chromatin condensation after in vivo treatment with phenobarbital

The transition of hepatocytes from G0 to late G1-phase was studied in phenobarbital (PB) treated rats using visual and cytofluorometric evaluations of nuclear fluorescence patterns after quinacrine dihydrochloride (QDH) staining. In controls, about 90% of the nuclei showed bright nuclear fluorescence indicating G0-phase. After 10 days there was a reduction in fluorescence intensity which became more marked with continued PB treatment, indicating a shift from a resting G0 state to a later G1 phase of the cell cycle. The relevance of these findings for the understanding of tumor promoting properties of PB is discussed.

Suppression of anti-hapten antibody responses by hapten-specific cytolytic T lymphocytes: role of I-A-associated antigen on target B lymphocytes

Cytolytic T lymphocytes (CTL) specific for 2,4,6-trinitrophenyl (TNP) determinants suppress the effector phase of a secondary anti-TNP antibody responses of murine syngeneic spleen cells in vitro. The cells mediating this suppression are hapten-specific, H-2-restricted, and possess properties typical of CTL. Moreover, the targets of the suppression appear to be antigen-primed B lymphocytes that are recognized by CTL via soluble antigen bound noncovalently to their Ig receptors. The effect of the CTL can be blocked by the addition of monoclonal antibodies directed against I-A molecules but not I-E or H-EK-encoded molecules on the target B cells, even in strain combinations in which the CTL-B cell interaction is restricted only by the H-2K and I regions of the MHC. This result suggests that B lymphocyte-bound antigen tends to associate preferentially with I-A rather than H-2K/D-encoded determinants, and that the suppressive effect of the CTL population is attributable to the minor subset that recognizes hapten-modified Ia antigens. These findings are also discussed in terms of the possible immunoregulatory function of Ia-restricted CTL.

[Sciatica in the elderly. Apropos of 27 cases operated after the age of 70]

From a study of 27 operations for common vertebral sciatica in the elderly, certain specific features stand out. L5 sciatica is predominant though curiously, the pain relieving posture is less frequent than in the S1 variety. The condition is usually most painful at night. In 50% of cases there is a motor deficit which to a great extend determines the decision to operate. Finally, there is very good correlation between clinical features and the discovery of a prolapsed disc. Osteoarthrotic lesions are much more common than in the general sciatica population but the disc protrusion always keeps its localising value. Surgical intervention reveals that the disc plays an equally important role at this age as a prolapsed disc was found in 26 cases (11 extruded herniated discs and 2 ruptured). These lesions are less common in the general sciatica population. In about two thirds of patients a herniated disc alone is found and in the others, it is associated with osteoarthrotic lesions although these do not appear to compromise the success of the operation. Amongst the 9 post-operative complications, there was one death due to pulmonary emboli and 2 cases of reflex algodystrophy of the foot on the operated side. With a mean delay of more than 1 year, a frank improvement was noted in 85% of cases as against 80% immediately following surgery. Only one case of recurrence was reported.

Suppression of anti-hapten antibody responses by hapten-specific cytolytic T lymphocytes: role of I-A-associated antigen on target B lymphocytes

Cytolytic T lymphocytes (CTL) specific for 2,4,6-trinitrophenyl (TNP) determinants suppress the effector phase of a secondary anti-TNP antibody responses of murine syngeneic spleen cells in vitro. The cells mediating this suppression are hapten-specific, H-2-restricted, and possess properties typical of CTL. Moreover, the targets of the suppression appear to be antigen-primed B lymphocytes that are recognized by CTL via soluble antigen bound noncovalently to their Ig receptors. The effect of the CTL can be blocked by the addition of monoclonal antibodies directed against I-A molecules but not I-E or H-EK-encoded molecules on the target B cells, even in strain combinations in which the CTL-B cell interaction is restricted only by the H-2K and I regions of the MHC. This result suggests that B lymphocyte-bound antigen tends to associate preferentially with I-A rather than H-2K/D-encoded determinants, and that the suppressive effect of the CTL population is attributable to the minor subset that recognizes hapten-modified Ia antigens. These findings are also discussed in terms of the possible immunoregulatory function of Ia-restricted CTL.

[Therapy of purulent peritonitis. Documentation of 78 cases and experience with taurolin (author's transl)]

From three different surgical departments 78 patients with purulent peritonitis are analyzed according to cause, origin, and extent of peritonitis. Operative therapy is presented. As additional antibacterial therapy the new chemotherapeutic agent, Taurolin, with antiendotoxin-effect is used. The postoperative course (temperature exceeding 38 degrees C, secondary wound healing, day of discharge, and serious complications) is correlated with pre- and intraoperative parameters; for instance, 1. postoperative fever occurs in one half of the patients, more frequently following perforation of stomach and duodenum; 2. every second patient shows secondary wound healing, this happens even more often in peritonitis arising from biliary disease or appendicitis; 3. in 29.5% of the patients serious complications arise, especially in patients with peritonitis originating in stomach, small intestine or large bowel; 4. overall mortality of 11.5% is surpassed in patients with peritonitis originating from small intestine or large bowel. The so-called peritonitis-index (calculated on the basis of pre- and intraoperative factors) shows a significant difference between survivors and patients dying during the postoperative course. In 80% of the 78 patients with purulent peritonitis taurolin was effective as a substitute for the usual antibiotics.

Light and electron microscopic appearance of rat peritoneal mast cells adhering to schistosomula of Schistosoma mansoni by means of complement or antibody

Metrizamide-gradient purified rat peritoneal mast cells were allowed to adhere to schistosomula of S. mansoni that had been preincubated in either minimum essential medium with 5% fetal calf serum (MEM/FCS), heat-inactivated serum from rats 8 weeks after cercarial infection (IRS) fresh normal rat serum as a source of complement (NRS), or IRS and NRS. Adherence was evaluated in sections 0.3 micrometers thick. The preincubation conditions favoring cell adherence were IRS + NRS greater than NRS greater than IRS greater than MEM/FCS. Greater adherence was seen at 60 min than at 10 min. Discharge of mast cell granulates was seen infrequently, was not greater in adherent than nonadherent cells, was not increased by any preincubation condition, and did not occur against the parasite's surface, as would be expected if antigen, antibody, and surface receptors were aggregated there. Electron microscopic examination showed that attachment to the parasite occurred through electron-dense material which was usually fibrillar in appearance. Membrane fusion, such as is seen between human neutrophils and schistosomula, did not occur.

[Cystadenomas and cystadenocarcinomas of the pancreas]

Benign or malignant cystadenoma of the pancreas is a rare but not exceptional tumor. Up to present, 300 of the former and 100 of the latter have been reported in the world literature. Three personal observations are reported, comprising 2 benign cystadenomas, the first discovered on abdominal palpation and the second after massive bleeding of gastric varices and thrombosis of the splenic vein. After removal of the tumor both patients were alive 20 and 7 1/2 years later respectively. Total excision of a cystadenocarcinoma in a third case required 90% pancreatectomy with ensuing diabetes. A review of the literature shows that total excision of a cystadenocarcinoma is always justified since the survival rate approximates 70%. This contrasts singularly with the catastrophic prognosis of pancreatic adenocarcinoma.

Mechanical versus pharmacologic prevention of deep venous thrombosis

The prevention postoperatively of deep venous thrombosis was studied using three different regimens in 227 patients undergoing surgical procedures. Seventy-six patients received 5,000 units of heparin subcutaneously and 0.5 milligrams of dihydroergotamine twice a day. In 76 patients, intermittent pneumatic compression of the legs was applied preoperatively and postoperatively with active physiotherapy. The last 75 patients received subcutaneously 5,000 units of heparin each eight hours. Systematic deep venous thrombosis detection was carried out using both the 125I fibrinogen test and the Doppler method, being confirmed by phlebography if positive. The 125I fibrinogen test proved to be more sensitive and more specific. The incidence of deep venous thrombosis and pulmonary embolism were comparable in the groups, mechanical prophylaxis being as effective as the two other regimens. No side-effects were noted with the use of intermittent compression boots. A venoconstricting agent associated with heparin may permit smaller doses with the same prophylactic effect.

Studies of the antibody-dependent killing of schistosomula of Schistosoma mansoni employing haptenic target antigens. II. In vitro killing of TNP-schistosomula by human eosinophils and neutrophils

Purified human eosinophils and neutrophils were compared for their capacity to mediate anti-TNP antibody-dependent killing of schistosomula of Schistosoma mansoni surface labeled with TNBS. In contrast with findings from studies employing human anti-schistosome sera and unmodified larvae, neutrophils in addition to eosinophils were found to be potent killers of schistosomula. Indeed, neutrophils proved to be consistently more effective than eosinophils in killing haptenated larvae throughout the dose response of each of the components (i.e., the TNBS surface label, rabbit anti-TNP sera and cells) of the in vitro reaction. The capacity of neutrophils to kill haptenated parasites is not likely to be due to the use of rabbit antibodies in the assays, since these cells were ineffective in killing unlabeled schistosomula when either rabbit or human anti-schistosome sera were employed. Furthermore, the ability of neutrophils to destroy TNP-labeled schistosomula does not appear to result from sublethal damage induced by the labeling procedure, since haptenated parasites were found to be no more susceptible than unmodified worms to killing mediated by anti-schistosome sera plus eosinophils or complement and, like unlabeled parasites, could not be killed by anti-schistosome sera plus neutrophils. The lethal interaction of neutrophils and haptenated schistosomula was preceded by a rapid and marked adherence of the cells to the worms, an effect that was not observed in the nonlethal interaction of neutrophils with schistosomula induced by anti-schistosome sera. The results argue, therefore, that the capacity of different granulocyte populations to kill schistosomula may be determined by the kinetics and intensity with which the effector cells adhere to the parasites. The findings further suggest that a key factor influencing the differential adherence of the cells to the parasites and their subsequent death may be the nature of the specific antigen-antibody interaction occurring at the surface of the larvae.

Studies of the antibody-dependent killing of schistosomula of Schistosoma mansoni employing haptenic target antigens. II. In vitro killing of TNP-schistosomula by human eosinophils and neutrophils

Purified human eosinophils and neutrophils were compared for their capacity to mediate anti-TNP antibody-dependent killing of schistosomula of Schistosoma mansoni surface labeled with TNBS. In contrast with findings from studies employing human anti-schistosome sera and unmodified larvae, neutrophils in addition to eosinophils were found to be potent killers of schistosomula. Indeed, neutrophils proved to be consistently more effective than eosinophils in killing haptenated larvae throughout the dose response of each of the components (i.e., the TNBS surface label, rabbit anti-TNP sera and cells) of the in vitro reaction. The capacity of neutrophils to kill haptenated parasites is not likely to be due to the use of rabbit antibodies in the assays, since these cells were ineffective in killing unlabeled schistosomula when either rabbit or human anti-schistosome sera were employed. Furthermore, the ability of neutrophils to destroy TNP-labeled schistosomula does not appear to result from sublethal damage induced by the labeling procedure, since haptenated parasites were found to be no more susceptible than unmodified worms to killing mediated by anti-schistosome sera plus eosinophils or complement and, like unlabeled parasites, could not be killed by anti-schistosome sera plus neutrophils. The lethal interaction of neutrophils and haptenated schistosomula was preceded by a rapid and marked adherence of the cells to the worms, an effect that was not observed in the nonlethal interaction of neutrophils with schistosomula induced by anti-schistosome sera. The results argue, therefore, that the capacity of different granulocyte populations to kill schistosomula may be determined by the kinetics and intensity with which the effector cells adhere to the parasites. The findings further suggest that a key factor influencing the differential adherence of the cells to the parasites and their subsequent death may be the nature of the specific antigen-antibody interaction occurring at the surface of the larvae.

Schistosomiasis: immunologic properties of developing schistosomula

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[Appendicular peritonitis: comparative study of antibiotic therapy and a topical bactericidal agent]

Fifty four patients operated on for appendicular peritonitis where randomly divided. In the first group intravenous Dalacin C and Spectacilline were given during five days postoperatively; in the second, Taurolin, a bactericid, was administered by intraperitoneal route. There was a statistical difference in either treatment, neither on intraperitoneal nor parietal septic complications. The use and way of prophylactic antibiotic administration are discussed.

[Detection of postoperative deep venous thromboses]

In 227 patients undergoing abdominal surgery, a Doppler ultrasonic examination to measure venous stop flow pressure and a 125I-fibrinogen test were systematically performed in order to detect postoperative deep venous thrombosis of the lower limbs (DVT). The 125I-fibrinogen test was abnormal in 19 patients in whom venography showed DVT in 18 cases (16 calf DVT and 2 femoral DVT). Five pulmonary embolisms were detected by lung scanning: lower limb venography was normal in one patient, calf DVT was found in 2 and femoral DVT in the last 2 patients. Among the 18 DVT, measurement of venous stop flow pressure by Doppler technique was abnormal in 4 cases including the 2 femoral DVT. This study confirms the value of the 125I-fibrinogen test in detecting asymptomatic postoperative DVT. The Doppler method serves to detect clinically symptomatic DVT with extension above the knee.

Studies of the antibody-dependent killing of schistosomula of Schistosoma mansoni employing haptenic target antigens. I. Evidence that the loss in susceptibility to immune damage undergone by developing schistosomula involves a change unrelated to the masking of parasite antigens by host molecules

A method was developed for coupling a hapten, trinitrophenyl (TNP), to the surface of schistosomula of Schistosoma mansoni which results in a minimal loss in their viability as judged by morphological examination in vitro and survival after injection in vivo. Skin-stage (3-h-old) and lung-stage (5-d-old) schistosomula surface labeled in this manner were then compared for their susceptibility to killing by anti-TNP antibody-dependent effector mechanisms both in vivo and in vitro. TNP skin-stage larvae were readily rejected in mice actively immunized against TNP bovine gamma globulin and were highly susceptible to anti-TNP-dependent killing mediated either by complement or purified human eosinophils in vitro. In contrast, TNP-lung-stage schistosomula, which were shown by microfluorimetry to bind anti-TNP antibody to approximately the same extent as skin-stage schistosomula, were found to be resistant to killing by the same in vivo and in vitro mechanisms. These findings suggest that the insusceptibility of postskin-stage schistosomula to antibody-dependent killing must result at least in part from an intrinsic structural change in the integument of the parasite and cannot be caused solely by the masking of parasite antigens by acquired host molecules, a mechanism of immune evasion previously proposed for schistosomes.

[Prevention of deep venous thrombosis (TVP) and pulmonary embolism. Comparison of heparin (3 x 5000 IU/day), heparin (2 x 5000 IU/day) + 0.5 mg dihydroergot, and physiotherapy (intermittent compression stockings + physical exercise). Value of Doppler diagnosis in systematic detection of TVP compared with phlebography and scanning of the legs using labelled fibrinogen]

We compared the protective value of the above treatments in 227 randomised patients. Investigations in each patient included pulmonary scanning before and after operation, repeated postoperative Doppler and radioactive limb scanning completed by phlebography to confirm positive results. The heparin DHE group and the "physiotherapic" group each totalized 76 patients and the heparin group 75. These comparable groups show that HDHE and heparin prophylaxis are identical; but physiotherapy is perhaps better. Compared with phlebography leg scanning sensitivity is 95%, whilst it's specificity is 99%. Doppler sensitivity is only of 21%, whilst it's specificity is 95%. In conclusion, "physiotherapic" prophylaxis, including Flowtron, is as effective as heparin alone. Doses of heparin may be reduced, without loss of effect, if supplemented by a veinoconstrictive agent as DHE. The low Doppler sensitivity contraindicates its use in asymptomatic DVT detection.